The national body had intended for these to be included in the cohort of vanguard sites announced in March, having asked interested parties to submit expressions of interest at the beginning of the year.

When launched, the vanguard was delayed because NHS England was not clear about the question bidders had to answer, Samantha Jones said

When it is established the viable smaller hospitals stream will form the fourth and final part of the vanguard, alongside sites already working to establish primary and acute care systems, multispecialty community providers, and enhanced health services in care homes.

The original specification suggested that the viable smaller hospitals vanguard could be the means by which NHS England implemented the findings of the Dalton review of the provider sector, which included the establishment of hospital chains among its recommendations.

The request for expressions of interest issued in January said small hospitals could focus on one of three areas:

becoming centres of excellence for elective care within particular specialisms;

delivering tertiary care across many sites “using an NHS franchise model”; or

establishing chains, or “foundation groups”, of district general hospitals providing a range of services, potentially working with larger teaching trusts.

Ms Jones told HSJ in March that this was one area of the vanguard that the largest teaching hospital providers could potentially become involved with. Several leading foundation trusts are already in “buddying” relationships with smaller struggling providers.

Historically ingrained health inequalities in England won’t be reversed by measures in the long-term plan, which require bigger “political and societal” interventions, according to a public health expert whose work contributed to the plan.